TY - JOUR
T1 - Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy
AU - Inamoto, Y.
AU - Ito, M.
AU - Suzuki, R.
AU - Nishida, T.
AU - Iida, H.
AU - Kohno, A.
AU - Sawa, M.
AU - Murata, M.
AU - Nishiwaki, S.
AU - Oba, T.
AU - Yanada, M.
AU - Naoe, T.
AU - Ichihashi, R.
AU - Fujino, M.
AU - Yamaguchi, T.
AU - Morishita, Y.
AU - Hirabayashi, N.
AU - Kodera, Y.
AU - Miyamura, K.
PY - 2009
Y1 - 2009
N2 - Intestinal transplant-associated microangiopathy (i-TAM) is an important complication after allogeneic hematopoietic SCT. From 1997 to 2006, 87 of 886 patients with diarrhea after transplantation received colonoscopic biopsy. i-TAM, GVHD and CMV colitis were diagnosed histopathologically. The median duration from transplantation to the onset of diarrhea was 32 days (range: 9-130 days) and that from the onset of diarrhea to biopsy was 12 days (range: 0-74 days). The median maximal amount of diarrhea was 2l/day (range: 130-5600ml/day). Histopathological diagnosis included i-TAM (n = 80), GVHD (n = 26), CMV colitis (n = 17) and nonspecific findings (n = 2) with overlapping. Among 80 patients with i-TAM, abdominal pain was a major symptom, and only 11 patients fulfilled the proposed criteria for systemic TAM. Non-relapse mortality (NRM) among patients without resolution of diarrhea was 72% and i-TAM comprised 57% of NRM. NRM was 25% among patients without intensified immunosuppression, but was 52, 79 and 100% among those with intensified immunosuppression before diarrhea, after diarrhea, and before and after diarrhea, respectively. In conclusion, i-TAM is a major complication presenting massive refractory diarrhea and abdominal pain, which causes NRM. Avoiding intensified immunosuppression that damages vascular endothelium until the resolution of i-TAM may improve transplant outcome.
AB - Intestinal transplant-associated microangiopathy (i-TAM) is an important complication after allogeneic hematopoietic SCT. From 1997 to 2006, 87 of 886 patients with diarrhea after transplantation received colonoscopic biopsy. i-TAM, GVHD and CMV colitis were diagnosed histopathologically. The median duration from transplantation to the onset of diarrhea was 32 days (range: 9-130 days) and that from the onset of diarrhea to biopsy was 12 days (range: 0-74 days). The median maximal amount of diarrhea was 2l/day (range: 130-5600ml/day). Histopathological diagnosis included i-TAM (n = 80), GVHD (n = 26), CMV colitis (n = 17) and nonspecific findings (n = 2) with overlapping. Among 80 patients with i-TAM, abdominal pain was a major symptom, and only 11 patients fulfilled the proposed criteria for systemic TAM. Non-relapse mortality (NRM) among patients without resolution of diarrhea was 72% and i-TAM comprised 57% of NRM. NRM was 25% among patients without intensified immunosuppression, but was 52, 79 and 100% among those with intensified immunosuppression before diarrhea, after diarrhea, and before and after diarrhea, respectively. In conclusion, i-TAM is a major complication presenting massive refractory diarrhea and abdominal pain, which causes NRM. Avoiding intensified immunosuppression that damages vascular endothelium until the resolution of i-TAM may improve transplant outcome.
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U2 - 10.1038/bmt.2008.419
DO - 10.1038/bmt.2008.419
M3 - Article
C2 - 19139727
AN - SCOPUS:67651087102
SN - 0268-3369
VL - 44
SP - 43
EP - 49
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 1
ER -